Predictive model of urinary tract infection after surgical treatment for women with endometrial cancer.

Abstract

The aim of the study was to identify risk factors associated with postoperative urinary tract infections (UTIs) following hysterectomy-based surgical staging in women with endometrial cancer. This is a retrospective study utilizing an institutional database (2008-2016) of stage I-IV endometrial cancer cases that underwent hysterectomy-based surgery. UTIs occurring within a 30-day time period after surgery were examined and correlated to patient clinico-pathological demographics. UTIs were observed in 44 (6.4%, 95% confidence interval 4.6-8.2) out of 687 cases subsequent to the diagnosis of endometrial cancer. UTI cases were significantly associated with obesity, advanced stage, prolonged operative time, hysterectomy type, pelvic lymphadenectomy, non-β-lactam antibiotics, and intraoperative urinary tract injury (all, p<0.05). On multivariate analysis, three independent risk factors were identified for UTIs: prolonged operative time [odds ratio (OR) 3.36, 95% CI 1.65-6.87, p=0.001], modified-radical/radical hysterectomy (OR 5.35, 95% CI 1.56-18.4, p=0.008), and an absence of perioperative β-lactam antibiotics use (OR 3.50, 95% CI 1.46-8.38, p=0.005). In a predictive model of UTI, the presence of multiple risk factors was associated with significantly increased risk of UTI: 4.1% for the group with no risk factors, 7.3-12.5% (OR 1.85-3.37) for single risk factor group, and 30.0-30.8% (OR 10.1-10.5) for two risk factor group. Urinary tract infections are common in women following surgical treatment for women with endometrial cancer with risk factors being a prolonged surgical time, radical hysterectomy, and non-guideline perioperative anti-microbial agent use. Consideration of prophylactic anti-microbial agent use in a high-risk group of postoperative urinary tract infection merits further investigation.